002105 (SATT)P.O. BOX 1504 No. 002105
Building 78-105 CALLE ESTADO
Address 80-41.7 Oak 7YM LA QUINTA, CALIFORNIA 92253
Owner
. .
" -BUILDING: -TYPE CONST.-•• - OCC: GRP.,
'Mailing.
Address iir 11,,,, A.P. Number
City Zip Tel.
Palm �. 92260 tr�8-:2 Legal. Description
Contractor Project Description OR
MU. MkIrtgaim MIA tMid
Address.
..City .swe . Zip - Tela
State -Lic. City
& Classif. 8Sq. Ft. 1330 No. No. Dw.
�� Lic. # ��� '
.Arch., Engr:, .. _ . ... ...
Size GNR '424 -Stories I Units- 1
,Designer New Add ❑ Alter ❑.- Repair ❑: Demolition ❑•
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section "
7000] of Division,3 of<the Business and Professions Code, and my licenseis in full force and
effect...
.. SIGNATURE fr f� !.!!'.�A'.r�'., r.Of. —..e / �- DATE ..
'• /' 'OUINER-BUILDER DECLARATION au
IEstimated Valuation
I hereby. affirm that I am exempt from the Contractor's License Law for the following,Ey Ott. �pAQ'
reason:. (Sec. 7031.5,Business and. Professions We: Any city or. county which requires a 17 f7 a _vi7a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permifjto file a signed, statement that -he is .licensed pursuant to .- PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter. 9 (commencing with Section :7000) of .
Division 3 of the Business and Professions Code, 'or that. he is exempt therefrom; and the basis
for the alleged exemption�,,4ny violation of Section 7031.5 by 'any applicant for a permit. Plan-Chk. Dep. 2M.00 '
subjects the applicant to a civil penalty of notmore than five hundred dollars ($500).
Bala :
O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. . 7A QA
do the work, and the stiuctuie is not intended or offered for sale: (Sec. '7044; Buisness and Const ';t� .
Professions Code: The Contractors License Law does not_ apply. to an owner of property who _
builds or improves thereon and who,does such work himself or through his own employees, Mech.. +",,�
provided that such improvements are not intended or offered for sale.. If, however,.the building. ,.
or improvement is sold within one year of completion,' the owner -builder will have the burden 'EIBCtrlcal
of proving that he did not,build or, Improve, for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project. (Sec. 7044, Business and Professions Coder The Contractor's License Law- _
does not apply to an owner of property who builds or improves thereon, andwho contracts for S.M.I. QQ
such projects with a contractor(s) licensed pursuant totherContractor's License Law.)
0 I am exempt under Sec,... B. & P.C. for this reason Grading
Driveway Enc.
Date owner Infrastructure 1.276.00
WORKERS' COMPENSATION DECLARATION
hereby affirm that I' have a certificate of consent to self -insure, or 'a certificate'of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. company
❑ Copy is filed with the city. _0 Certified copy is hereby. furnished..
TOTAL -1 74 •FEZ _432< 42
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE _
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) -
I certify that in the performance of the work for which this permit is issued, I shall not, SL'K1f'Yt _ 711A�1i �rFyi* s t awA
employ any person in any manner so as to become subject to the Workers' Compensation `
Laws of California.
—DWe - Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption *you should become ZONE: BY:
'subject to the Workers'. Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: '
comply with such provisions or this permit shall be deemed revoked. - -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097„Civil code.) Side Setback from. Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
This is.a-building permit when properly filled out, signed and validated, and is subject to, '
expiration it work thereunder is suspended for 180 days. I 2_�6t
I certify that I have read this application -and state that'fhe above information is correct: Issued by: Date 3— 66 Permit
I agree to comply with all city and county ordinances and state' laws relating to building
construction, and hereby authorize representatives..of this city to: enter the above-.
mentioned property Tor inspection purposes! ti Validated by:
Signature of applicant �P %�'p.e` i �r w' Date
Mailing. Address f. -t �' .C�Ci/ ✓ ” """` _ Validation: '
City, State, Zip
A 4 5 8 0 3 6).929,42 (l
HARD COPY _ _ .. .
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES Ain,
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE /1Z
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. Q
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT S ' 2�
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT . WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Ya c
SEWAGE DISPOSAL
LATHING 2
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
2�INSULATION/SOUND Ir�r L�
U
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK j / 6
rL.&OUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE /1Z
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWUR SEPTIC Pig
12,4�3OUGH WIRING f
>
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL L
GAS (FINAL)
TEMP. POLE
GROUT S ' 2�
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
VENTILATION L
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 2
MESH
2�INSULATION/SOUND Ir�r L�
U
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL
pp -/-w/ s/ 6/10 yz�